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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash flows from operating activities      
Net income $ 57,849 $ 45,741 $ 46,055
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 17,748 17,543 17,517
Amortization of debt issuance cost 1,061 939 1,078
Share-based compensation 22,040 16,101 6,745
Non-cash lease expense 7,183 3,759 3,133
(Income) loss from equity method investments, net (5,579) (5,622) 4,306
Unrealized loss on investments 4,782 25,506 10,845
Unrealized (gain) loss on interest rate swaps (201) (4,235) 1,071
Gain on sale or distribution of investments (1,246) (2,272) (2,193)
Deferred tax (12,444) (14,278) 7,671
Loss (gain) on consolidation of equity method investment 0 901 (2,752)
Gain on contingent equity securities 0 0 (4,270)
Gain from investment in warrants 0 0 (1,145)
Impairment of beneficial interest 0 0 15,723
Other 422 0 189
Changes in operating assets and liabilities, net of acquisition amounts:      
Receivable, net (26,735) (38,194) (1,518)
Receivable, net – related parties 6,167 4,229 (20,116)
Other receivable 311 8,196 (5,351)
Prepaid expenses and other current assets (2,956) 818 2,708
Other assets 2,864 (243) (1,529)
Accounts payable and accrued expenses (170) (49) 3,217
Fiduciary accounts payable (328) (2,470) 892
Medical liabilities 18,610 22,786 5,279
Income taxes payable/receivable (14,477) 6,917 (14,005)
Operating lease liabilities (6,674) (3,945) (3,215)
Net cash provided by operating activities 68,227 82,128 70,335
Cash flows from investing activities      
Payments for business and asset acquisition, net of cash acquired (6,512) (16,352) (2,585)
Proceeds from repayment of loans receivable - related parties 2,676 4,067 56
Purchases of marketable securities (2,151) (1,854) (28,000)
Proceeds from sale of marketable securities 491 31,671 67,612
Issuance of loans receivable (26,473) 0 0
Purchases of investments –privately held (4,000) 0 0
Purchases of property and equipment (28,529) (22,940) (19,223)
Purchases of investments – equity method (325) 0 (13,622)
Proceeds from sale of equity method investment 0 0 6,375
Distribution from investment - equity method 0 400 0
Contribution to investment - equity method (700) (2,105) 0
Cash recorded from consolidation of VIE 0 0 5,927
Net cash (used in) provided by investing activities (65,523) (7,113) 16,540
Cash flows from financing activities      
Dividends paid (62,074) (14,030) (31,089)
Repayments on long-term debt (204,681) (3,865) (238,326)
Borrowings on long-term debt 284,527 3,598 180,569
Payment of finance lease obligations (675) (561) (208)
Proceeds from exercise of stock options and warrants 1,522 8,633 9,061
Repurchase of shares (10,192) (9,250) (5,739)
Proceeds from sale of common stock 0 0 40,134
Purchase of non-controlling interest (78) (5,046) (1,471)
Proceeds from sale of noncontrolling interest 0 436 48
Cost of debt issuances (3,928) 0 (727)
Payment of contingent consideration liabilities (1,000) 0 0
Net cash provided by (used in) financing activities 3,421 (20,085) (47,748)
Net increase in cash, cash equivalents, and restricted cash 6,125 54,930 39,127
Cash, cash equivalents, and restricted cash, beginning of year 288,027 233,097 193,970
Cash, cash equivalents and restricted cash, end of year 294,152 288,027 233,097
Supplemental disclosures of cash flow information      
Cash paid for income taxes 56,567 47,311 37,201
Cash paid for interest 14,251 6,672 4,158
Supplemental disclosures of non-cash investing and financing activities      
Right-of-use assets obtained in exchange for operating lease liabilities 25,124 0 0
Tax impact from APC dividends to APC Shareholders 3,076 0 0
Distribution of real estate investments 152,767 0 0
Dividend declared included in dividend payable 0 0 71
Issuance of financing obligation for business combinations 0 0 12,706
Cashless exercise of warrants 0 694 0
Fixed asset obtained in exchange for finance lease liabilities 486 971 0
Common stock issued in business combination 800 1,000 0
Mortgage loan 0 16,275 0
Cancellation of Restricted Stock Awards 0 0 334
Reconciliation of cash, cash equivalents, and restricted cash      
Cash and cash equivalents 293,807 288,027 233,097
Restricted cash 345 0 0
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 294,152 $ 288,027 $ 233,097

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